多节段髓内先天性肿瘤和良性室管膜瘤的对比分析

Comparative analysis between multi-segments intramedullary spinal cord congenital tumors and benign ependymomas

目的:对比分析多节段髓内先天性肿瘤和良性室管膜瘤患者在性别、年龄分布,以及肿瘤部位、瘤体长度、切除程度和对围手术期神经功能状况影响方面的异同。方法:选取北京大学第三医院近8年来连续收治的12例多节段(≥3个椎体节段)髓内先天性肿瘤和19例良性室管膜瘤患者,均行后正中入路显微镜下肿瘤切除术。收集患者临床资料,将二便功能状态分为4级(正常,尿频或/和便秘等轻度异常,排便困难、无力等中度异常,失禁),以改良JOA评分系统(improved Japanese orthopaedic association score system,IJOA)评价神经功能状况,以IJOA分值差(术后IJOA和术前IJOA差值)评估手术效果。所有患者随访至2009年6月30日。以独立样本的t检验和非参数检验分析统计学数据。结果:先天性肿瘤患者的平均年龄为(23.5±14.3)岁,良性室管膜瘤患者为(37.8±12.9)岁,差异有统计学意义(t=-2.89,P=0.007)。两组性质不同的多节段髓内肿瘤比较,其肿瘤部位(Z=-3.59,P=0.001)和肿瘤切除程度(Z=-2.89,P=0.004)差异均有统计学意义。83.3%(10/12)患者的多节段髓内先天性肿瘤累及脊髓圆锥部位,部分肿瘤和脊髓结构粘连紧密或脂肪组织穿插生长在神经结构中,为避免神经功能的缺失,不能强行切除粘连紧密的肿瘤组织,其中66.7%(8/12)肿瘤组织得以全部切除或近乎全部切除。78.9%(15/19)患者的多节段髓内良性室管膜瘤累及颈段或颈胸段脊髓,其中94.7%(18/19)肿瘤组织得以全部切除或近乎全部切除。结论:多节段髓内先天性肿瘤可能多见于青年患者,常累及脊髓圆锥,部分肿瘤全部切除难度较大;多节段髓内良性室管膜瘤可能多见于中年患者,常累及颈段或颈胸段脊髓,肿瘤全部切除较容易。

Objective：To comparatively analyze the different and common points between multi-segments intramedullary spinal cord congenital tumors and benign ependymomas,such as the patient＇s age,gender,nervous functions and tumor location,longitudinal extension,and removed extent.Methods： Data were studied from 12 patients with multi-segments intramedullary spinal cord congenital tumors and 19 patients with multi-segments intramedullary spinal cord benign ependymomas who underwent microsurgery for the tumor using a posterior approach.The tumor was exposed through dorsal myelotomy.Preoperative and postoperative nervous functions were scored using the Improved JOA（improved Japanese orthopaedic association,IJOA） score system.Independent sample t-test was performed for ages,preoperative IJOA scores,postoperative IJOA scores and IJOA difference values of the patients,and longitudinal extension of tumors in the two groups with congenital tumors and benign ependymomas.Two independent sample Mann-Whitney tests was performed for the patient＇s gender,stool and urine functions,limbs weakness,and tumor removed extent in the two groups.All patients were followed-up until Jun.30,2009.Results： The average age of patients in congenital tumors group was 23.5±14.3,and in benign ependymomas group was 37.8±12.9,the age difference between the two groups was statistically significant（t=-2.89,P=0.007）.The difference for location（Z=-3.59,P=0.001）and removed extent（Z=-2.89,P=0.004） of tumors between the two groups was statistically significant.Those located at the conus accounted for almost 83.3%（10/12）multi-segments intramedullary spinal cord congenital tumors.Because of the stiff adhesion with adjacent neural structures or penetrative growth in surrounding spinal marrow,some congenital tumors could not totally removed by force.The main purpose of surgery for these tumors was not total removal but decompression on the adjacent neural structures.Total or nearly total resection was achieved in 66.7%（8/12）patients diagnosed with congenital tumors.78.9（15/19）percent of multi-segments intramedullary spinal cord benign ependymomas were located at the cervical and cervicothoracic segments.Total or nearly total resection was achieved in 94.7%（18/19）patients with benign ependymomas.Conclusion： It is known from the clinical files that most multi-segments intramedullary spinal cord congenital tumors are found in young patients and most benign ependymomas in the middle-aged.Most congenital tumors are located at the conus,and they are difficult to totally remove.Most benign ependymomas are located at the cervical and cervicothoracic segments,and they are easy to totally remove.